Poster with mini oral Clinical Oncology Society of Australia 2014 Annual Scientific Meeting

Do patients with advanced cancer want to discuss and pay for unfunded expensive anticancer drugs? (#204)

Linda Mileshkin 1 2 , Edward Livshin 1 , Jeremy Lewin 1 , Sandra Harvey 3 , Mark Voskoboynik 1 , Emilia Agalianos 1 , Penelope Schofield 1 , Alan Herschtal 1 , Aparna Rao 1 , Ian Collins 1 , Damien Urban 1 , George Au-Yeung 1 , John Zalcberg 1
  1. Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
  2. Peter MacCallum Cancer Centre, East Melbourne, Australia
  3. Bankstown-Lidcome Hospital, Bankstown, NSW, Australia

Background:
Australian medical oncologists commonly may not discuss unfunded expensive anticancer drugs (EACDs), because of concern about causing distress. We aimed to evaluate the views of patients with advanced cancer about this issue .
Methods:
Eligible patients completed a questionnaire regarding their views on 4 hypothetical scenarios involving an EACD. The scenarios described EACDs associated with either improved overall survival of 4-6 months (OS), encouraging response rate (RR) in a treatment-refractory situation, improved treatment tolerability/quality of life (QOL), or an improvement in progression-free survival of 4 months (PFS).
Results:
176 patients participated (response rate: 94%). 156 patients (89%) wanted their oncologist to discuss a relevant EACD with 23 (13%) having previously discussed an EACD. Most wanted their oncologist to tell them about the 4 EACDs: improved OS = 72%, encouraging RR = 91%, better QOL = 86%, improved PFS = 90%; and receive the treatments (55-71%). Those not wanting discussion were mostly concerned about either themselves (47%) or their family (40%) becoming distressed. Desire to be told about the EACD or receive treatment did not vary significantly by disease-type or demographic factors and most thought the government should pay for the EACD (81-86%). Compared to results from our general public survey, eligible patients were less likely to want to pay for an EACD (29-40% vs 51-76%) and less likely to consider paying if they were female or single. Most participants would change their mind about paying if they could easily afford it, treatment was curative, or PFS could be extended by > 24 months.
Conclusion:
Most patients with advanced cancer want to be told about EACD treatment options by their oncologists, even if they are unwilling or unable to pay for them. Oncologists need to be realistic when discussing potential benefits of EACD’s and remain sensitive to the distress it may cause.

  1. L. Mileshkin, P. Schofield, M. Jefford, E. Agalianos, M. Levine, A. Herschtal, J. Savulescu, J. Thomson, J. R. Zalcberg. To tell or not to tell?: The community wants to know about expensive anti-cancer drugs as a potential treatment option. J Clin Oncol 2009 Dec 1;27(34):5830-7
  2. Thomson J, Schofield P, Mileshkin L, Agalianos E, Savulescu J, Zalcberg J, Jefford M. Do oncologists discuss expensive anti-cancer drugs with their patients? Ann Oncol. 2006 Apr;17(4):702-8.